Alpha-hydroxy carboxylic acid and derivatives and other GRAS based prodrugs of oxycodone and uses thereof

ABSTRACT

The invention describes pharmaceutical compounds and compositions comprised of a ligand attached to the opioid oxycodone, in a manner that substantially decreases or deters the potential for opioid abuse, addiction, illicit and illegal use, and overdose. When delivered at the proper dosage, the pharmaceutical composition provides therapeutic activity similar to that of the parent active agent.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a continuation application of U.S. patent application Ser. No. 14/953,392, filed Nov. 29, 2015, which claims the benefit of U.S. Provisional Application No. 62/153,157, filed Apr. 27, 2015.

FIELD OF INVENTION

The present invention relates to pharmaceutical compounds, compositions, and methods of using chemical moieties that are generally recognized as safe (GRAS), which are attached to the opioid oxycodone. These chemical moieties are monomers, homo- and hetero-oligomers of alpha-hydroxy carboxylic acids, and their chemical derivatives. These inventions provide a variety of beneficial effects, particularly a substantial decrease in the potential of oxycodone to cause overdose or to be abused. Some embodiments of the invention provide therapeutic activity similar to that of unmodified oxycodone when delivered at typical dosage ranges, but when delivered at higher doses, the potential for overdose is reduced due to decreased bioavailability of oxycodone, especially when taken by non-approved routes, as compared to oxycodone that is administered by the approved oral route and delivered in a non-conjugated form. Additionally, these prodrugs may be designed to provide fast or slow release of oxycodone depending on its standard use for chronic or acute pain.

BACKGROUND OF THE INVENTION

Proper medical treatment of pain remains a challenge for patients and healthcare professionals. Optimal pharmacologic management of pain requires selection of analgesic drugs that achieve rapid efficacy with minimal side effects. Traditionally, opioid analgesics have provided the most important options for pain treatment. However, misuse and abuse of opioids is a widespread social and medical problem and may deter physicians from prescribing these useful drugs.

In addition, accidental and intentional overdose with prescription and/or over-the-counter (OTC) drugs is a serious health problem that is associated with thousands of fatalities every year. Opioid overdose is a significant and growing problem associated with drug abuse, but overdoses also occur accidentally (for example when a child obtains and ingests an opioid), or intentionally (e.g., when related to suicide attempts). Accidental overdose can also commonly occur when unusually potent batches of illicit opioids are ingested by drug addicts or other abusers

Opioid abuse is an increasing problem, and oxycodone has become one of the most widely abused drugs. The drug is known as “a poor man's heroin” because of its comparatively lower street price. Moreover, crushing and snorting intranasally the delayed release form of oxycodone (known by the brand name as Oxycontin®), results in rapid drug release and absorption, which results in high peak blood concentrations that produce a quick “high” but can also precipitate a fatal overdose (Aquina et al (2009) Post Graduate Medicine 121: 163-167). Necrosis of intranasal structures, similar to the damage associated with cocaine use, is also a consequence prolonged Oxycontin® abuse by snorting crushed tablets.

A further shortcoming of many opioids is their generally low oral bioavailability. The poor oral bioavailability results in variable blood levels, and consequently variable patient response—a highly undesirable feature in the treatment of pain where rapid and reliable relief is critical.

Researchers and the pharmaceutical industry have sought to prevent the potential harmful effects of opioid overdose by creation of various drug formulations. For example, opioids have been combined with opioid antagonists. Such formulations are designed to counteract an oral opioid if the formulation is disrupted (e.g., crushed) prior to oral administration, or if the drug is taken administered parenterally (e.g., injected intravenously). To cite an example of a non-opioid drug with known abuse potential, extended release methylphenidate (Concerta®) has been formulated in a paste that can preclude administration by snorting or injection. Other compositions have been coated with emetic agents in quantities that—if administered in moderation as intended—no emesis occurs; however, if excessive amounts are ingested, emesis is induced to prevent overdose. However, such methods, as well as conventional controlled-release formulations, are often ineffective and can be circumvented.

In addition to Oxycontin®, oxycodone is also an ingredient of well-known drugs such as Percodan®, Percocet®, Roxicet®, and Tylox®. As a semi-synthetic narcotic derived from thebaine, oxycodone is also available in oral formulations combined with aspirin, phenacetin, and caffeine. A typical adult dose of oxycodone is 2.5-5 mg administered orally as the hydrochloride or terephthalate salt every 6 hours. While typically used for the relief of moderate to moderately severe pain, oxycodone can also produce drug dependence of the morphine type. Therapeutic plasma concentrations for analgesia typically range from 10-100 ng/mL, and the toxic plasma concentration is greater than 200 ng/mL.

Various types of prodrugs have been proposed to improve the oral bioavailability of opioids. These have included simple ester conjugates that are subject to hydrolysis by plasma esterases.

Moreover, the rapidity of ester hydrolysis within the gut or through first-pass metabolism in the liver has further limited the utility of this approach. More sophisticated ester-conjugated opioid prodrugs have been synthesized. However, in the 20 years since ester conjugates were first reported, no such prodrugs have been approved as marketed products, which suggests that this approach has not been successful.

Consequently, improved methods are urgently needed to make pharmaceutically effective oxycodone compounds, along with compositions and methods of using such compounds, to reduce the potential for overdose and to reduce or deter opioid substance abuse while maintaining their intended analgesic utility. Potentially useful compounds may also prevent—or substantially diminish or delay—uptake into the brain if the compounds were administered by routes other than approved oral administration.

Ideally, a prodrug moiety and its linkage to a particular opioid would be cleaved at an appropriate rate and site, which would then release the active opioid compound into the blood and provide the intended analgesic benefit. There remains a critical need for the treatment of severe pain with opioids using products that retain all their pharmacological advantages but sharply reduce their principal limitations, including adverse gastrointestinal effects (e.g., constipation), variable bio availability after oral dosing, non-opioid overdose, and misuse, illegal/illicit use, and product tampering.

SUMMARY

Provided are pharmaceutical compounds, compositions, and methods of using such compounds and compositions. Also provided are methods of using chemical moieties that are generally recognized as safe (GRAS), which are attached to the opioid oxycodone. These chemical moieties are monomers, homo- and hetero-oligomers of alpha-hydroxy carboxylic acids, and their chemical derivatives. The compounds may provide a substantial decrease in the potential of oxycodone to cause overdose or to be abused. In some embodiments the oxycodone prodrug conjugates provide therapeutic activity which is similar to that of unmodified oxycodone when delivered at typical dosage ranges. However, when delivered at higher doses the potential for overdose is reduced as compared to conventional non-conjugated oxycodone due to decreased bioavailability of the oxycodone, especially when taken by non-approved oral routes. Additionally, the prodrugs may be designed to provide fast or slow release of oxycodone depending on its standard use for chronic or acute pain.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1-41 present the rat oral PK profiles of representative oxycodone prodrug conjugates described herein.

DETAILED DESCRIPTION OF THE INVENTION

A first aspect of the invention relates to changing the pharmacokinetic and pharmacological properties of oxycodone through covalent modification using alpha-hydroxy carboxylic acid and derivatives and other generally recognized as safe (GRAS)-based moieties to produce prodrugs of oxycodone. Covalent attachment of a chemical moiety—specifically, a moiety derived from novel alpha-hydroxy carboxylic acid and derivatives and other GRAS-based reagents as monomers and oligomers (homo and hetero oligomers)—to oxycodone may change one or more of the following properties of oxycodone: the rate of absorption; extent of absorption and distribution within the body; metabolism and drug elimination (i.e., ADME pharmacokinetic properties). As such, the alteration of one or more of these characteristics may be designed to provide fast or slow release, depending on need for relief of chronic pain versus acute pain. Additionally, alteration of one or more of these characteristics may reduce the previously noted side effects associated with oxycodone. In turn, these alterations may diminish or deter abuse potential. The oligomers formed from alpha-hydroxy carboxylic acid and derivatives can be homo and hetero ‘mers’ and can be both linear and branched ‘mers’. The hetero ‘mers’ can be cross linked with other GRAS reagents such as amino acid and dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid.

The oxycodone prodrug may also prevent abuse by exhibiting stability under conditions that are likely to be employed by chemists who may illicitly attempt to release the oxycodone compound from its attached group. The oxycodone prodrug may further prevent abuse by exhibiting reduced bioavailability when administered via parenteral routes, particularly by intravenous, intranasal, or inhalation (“smoking”) routes that are often employed in illicit use. Thus, the oxycodone prodrug may reduce the desired euphoric effect with oxycodone abuse. Thus, the oxycodone prodrug may prevent, deter, or reduce abuse potential and overdose when the oxycodone prodrug is used in an unapproved manner (e.g., ingestion at a higher dose or non-oral administration).

Oxycodone prodrugs of the present invention may be depicted as structures shown below as Formula A and Formula B where moieties X and Y represent the prodrug components that are chemically/covalently attached to oxycodone at the 6^(th) and 14^(th) position oxygen atoms of oxycodone, or a pharmaceutically acceptable salt thereof. X and Y, if Y is present, can be the same or different. As shown in Formula A, if Y is not present the oxycodone prodrug has a hydroxyl group at the 14^(th) position, and X may be any of the prodrug components described herein. As further described hereinbelow, if both X and Y are present they may be the same or different, and each of X and Y may be independently selected from any of the prodrug components described.

Alpha-hydroxy carboxylic acids and other GRAS-based monomers used to make the monomer-based and oligomer-based oxycodone prodrugs are depicted below.

It should be emphasized that the following chemical moieties represent non-limiting examples of alpha-hydroxy carboxylic acids and other GRAS-based monomers which may be used to make the monomer-based and oligomer-based oxycodone prodrugs of the present invention:

The alpha-hydroxy carboxylic acids represented here include the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and meso-isomers.

The amino acids represented here include both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers.

The amino acids represented here also include alpha amino acids, beta amino acids, gamma amino acids, and epsilon amino acids (remote amino group relative to the carboxyl group).

The fatty acids represented here include long-chain carboxylic acids, ranging in carbon lengths between eight carbons (C8) to twenty carbons (C20). These fatty acids could be both linear and branched and both saturated and non-saturated. In the case of unsaturated fatty acids they could be both cis- and trans-isomers (Z and E isomers).

In one embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, CZ=CH2, CHOR1, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids, acyl groups from amino acids, and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and, R=Methyl (Me), Phenyl (Ph), CH2COR2, CHOR1COR2, and COR2 (when n is not zero), where R2=OH, or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and, n is an integer selected from 0 to 2.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and, R and R3 can be same or different, and, R and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and, m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R and R3 can be same or different, and R and R3=Me, Ph, CH2COR2, CHOR1COR2, Where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R and R3 can be same or different, and R and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids, and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and, m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid and R and R3 can be same or different, and R and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and m is an integer selected from 0 to 4.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as

Wherein, CZ=CH2, CHOR1; R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R and R3 can be same or different, and R and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and R4 together with the adjacent nitrogen atom is part of an amino acid, and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2, and p is an integer selected from 0 to 1.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, CZ=CH2, CHOR1; R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids, and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R and R3 can be same or different, and R and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and R5=H, COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, or alkyl esters (O-alkyl, alkyl group is 1-4 carbon linear and branched, saturated and non-saturated alkyl groups), and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2, and p is an integer selected from 0 to 1, and v is an integer selected from 0 to 5.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, CZ=CH2, CHOR1; R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and R4 together with the adjacent nitrogen atom is part of an amino acid and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2,

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, CZ=CH2, CHOR1; R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and R5=H, COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, or alkyl esters (O-alkyl, alkyl group is 1-4 carbon linear and branched, saturated and non-saturated alkyl groups), and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2, and is an integer selected from 0 to 5.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, Where CW=(CH2)q, CH═CH (both E and Z isomers), CZ=CH2, CHOR1; R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and R6=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, or alkyl esters (O-alkyl, alkyl group is 1-4 carbon linear and branched, saturated and non-saturated alkyl groups), and, the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2, and q is an integer selected from 2 to 6.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, Where CW=(CH2)q, CH═CH (both E and Z isomers), CZ=CH2, CHOR1; R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids and acyl groups from amino acids, and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, and R and R3 can be same or different, and R and R3=Me, Ph, CH2COR2, CHOR1COR2, Where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and the amino acids represented here depicts both natural and non-non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and R6=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, or alkyl esters (O-alkyl, alkyl group is 1-4 carbon linear and branched, saturated and non-non-saturated alkyl groups), and the amino acids represented here depicts both natural and non-non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2, and q is an integer selected from 2 to 6.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, CW=(CH2)q, CH═CH, (both E and Z isomers), and R3=Me, Ph, CH2COR2, CHOR1COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and the amino acids represented here depicts both natural and non-non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, R5=H, COR2, where R2=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, or alkyl esters (O-alkyl, alkyl group is 1-4 carbon linear and branched, saturated and non-non-saturated alkyl groups), and, R6=OH or is part of an ester formed by the alcohol (OH) part of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, or alkyl esters (O-alkyl, alkyl group is 1-4 carbon linear and branched, saturated and non-non-saturated alkyl groups), and, m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2, and q is an integer selected from 2 to 6, and v is an integer selected from 0 to 6.

In another embodiment of the present invention, the prodrug components X and Y, if Y is present, may be the same or different and may be represented as,

Wherein, FA is C8 to C20 saturated and unsaturated fatty acids including sorbic acid, stearic acid, oleic acid, palmitic acid, linoleic acid. These fatty acids could be both linear and branched chain acids, and in the case of unsaturated fatty acids they could be both cis- and trans-isomers (Z and E isomers).

In another embodiment of the present invention, the prodrug side chain is attached to (i.e., bonded to) one of two (or both) possible locations in the oxycodone molecule. For example, oxycodone has hydroxyl groups at carbon 14 and a ketone oxygen at carbon 6. A monomer prodrug side-chain or an oligomer prodrug side-chain can be bound at either or both of these positions, and upon prodrug side-chain cleavage, the oxycodone will revert back to its original form.

With the ketone group present at the 6 position of oxycodone, the ketone can be converted to its corresponding enolate and reacted with an activated prodrug side chain reactant to form a prodrug. Upon prodrug cleavage, the prodrug will revert back to the original opioid molecule, with the keto group present.

If the prodrug chain is attached only to the ketone enolate oxygen at the 6 position of oxycodone, it is the prodrug ester of the mono-series (mono-substitution), and if the prodrug chain is attached to both at the hydroxyl groups at carbon 14 and at the ketone enolate oxygen at the 6 position of oxycodone, it is the prodrug ester of the bis-series (di-substitution). Upon cleavage of the prodrug side-chains, the prodrug will revert back to the original oxycodone molecule, with the keto group and hydroxyl group present and intact.

The alpha-hydroxy carboxylic acid and its homo and hetero oligomers (with another alpha-hydroxy carboxylic acid) referred to in this invention should be understood to be covalently bound via a hydroxy group on the alpha-hydroxy carboxylic acid or on the oligomer to another carbonyl (originally part of a carboxyl group of another alpha-hydroxy carboxylic acid, or to another carbonyl of the carboxyl group of the amino acid, or to one carbonyl of the carboxyl group of a dicarboxylic acid (e.g., succinic acid, maleic acid, fumaric acid), while the carboxyl group from the initial alpha-hydroxy carboxylic acid is attached to oxycodone.

If the initial carboxyl group that is attached to the oxycodone referred to in this invention is from an amino acid, it should be understood that the amino group of the said amino acid is to be bound via a covalent bond as the amide with the carboxyl group on the alpha-hydroxy carboxylic acid or the oligomer carbonyl (originally part of a carboxyl group of the alpha-hydroxy carboxylic acids) or to one carbonyl of the carboxyl group of a dicarboxylic acid (e.g., succinic acid, maleic acid, fumaric acid).

It should also be understood that if the initial carboxyl group that is attached to the oxycodone referred to in this invention is from alpha-hydroxy carboxylic acids and its homo and hetero oligomers (with another alpha-hydroxy carboxylic acid), the ensuing hydroxyl group may be capped as its ester by fatty acids.

It should also be understood that if the initial carboxyl group that is attached to the oxycodone referred to in this invention is from alpha-hydroxy carboxylic acids and its homo and hetero oligomers (with another alpha-hydroxy carboxylic acid), the ensuing hydroxyl group may be capped as its ester by dicarboxylic acids (e.g., succinic acid, maleic acid, fumaric acid).

In another embodiment of the present invention, when the covalently modified oxycodone is provided in oral dosage form (e.g., a tablet, capsule, caplet, liquid dispersion, etc.) it has increased resistance to manipulation. For instance, crushing of a tablet or disruption of a capsule does not substantially increase the rate and amount of oxycodone absorbed when compositions of the invention are ingested.

In another embodiment of the present invention, when the oxycodone covalently bound to the prodrug side chain is provided in oral dosage form; for example a tablet, capsule, caplet or other formulation that is resistant to generate oxycodone by physical manipulation such as crushing.

Another embodiment of the present invention provides oxycodone prodrug conjugates as a composition or method for treating pain in a patient (i.e., acute and chronic pain). It should be noted that different conjugates may be be utilized to treat acute versus chronic pain.

Another embodiment of the present invention is a composition or method for a sustained-release oxycodone comprising a covalently bonded oxycodone conjugate, wherein said conjugate provides release of oxycodone at a rate where the level of oxycodone is within the therapeutic range, but below toxic levels, over an extended period of time (e.g., 8-24 hours or greater).

Another embodiment of the present invention is a composition or method for reducing variability in bioavailability, or preventing a toxic release profile of oxycodone, comprising oxycodone covalently bonded to the prodrug moiety wherein said bound oxycodone maintains a steady-state serum release curve, which provides therapeutically effective bioavailability but prevents spikes or sharp increases in blood concentrations compared to unbound oxycodone when given at doses exceeding those that are within the therapeutic range of oxycodone.

Another embodiment of the invention is a composition or method for preventing a C_(max) spike for oxycodone while still providing a therapeutically effective bioavailability curve comprising oxycodone which has been covalently bonded to the prodrug moiety.

Another embodiment of the present invention is a method for reducing or preventing abuse related to the euphoric effect of a pharmaceutical opioid composition, comprising consuming said composition, wherein said composition comprises a prodrug moiety covalently attached to oxycodone, such that the pharmacological activity of oxycodone is substantially decreased when the composition is used in a manner inconsistent with approved instructions or in a manner that substantially decreases the potential of overdose from oxycodone.

Other embodiments of the present invention are methods wherein said pharmaceutical composition is adapted solely for oral administration, and wherein said oxycodone is resistant to release from said prodrug moiety when the composition is administered parenterally (e.g., intranasally, intravenously. etc.). Preferably, said oxycodone would be preferentially released from said chemical moiety primarily in the presence of acid and/or enzymes present in the stomach or intestinal tract, respectively.

In another embodiment of the present invention, the covalently bonded oxycodone prodrug may also be in a pharmaceutically acceptable salt form. Pharmaceutically acceptable inorganic and organic acid addition salts are known in the art. Exemplary salts include, but are not limited to, hydrobromide, hydrochloride, hydroiodide, benzoate, bisulfate, tartrate, bitartrate, edetate, edisylate, estolate, esylate, ethanesulfonate, lactate, malate, maleate, mandelate, methanesulfonate, phosphate, 2-hydroxyethanesulfonate, 2-naphthalenesulfonate, 3-hydroxy-2-naphthoate, 3-phenylpropionate, acetate, adipate, alginate, amsonate, aspartate, benzenesulfonate, borate, butyrate, calcium edetate, camphorate, camphorsulfonate, citrate, clavulariate, cyclopentanepropionate, digluconate, dodecylsulfate, finnarate, gluceptate, glucoheptanoate, gluconate, glutamate, glycerophosphate, glycollylarsanilate, hemisulfate, heptanoate, hexafluorophosphate, hexanoate, hexylresorcinate, hydrabamine, hydroxynaphthoate, isothionate, lactobionate, laurate, laurylsulphonate, mucate, naphthylate, napsylate, nicotinate, N-methylglucamine ammonium salt, oleate, palmitate, pamoate, pantothenate, pectinate, phosphateldiphosphate, pivalate, polygalacturonate, propionate, p-toluenesulfonate, saccharate, salicylate, stearate, subacetate, succinate, sulfate, sulfosaliculate, suramate, tannate, teoclate, tosylate, triethiodide, undecanoate, and valerate salts, and the like.

The term “amino acid” refers to one of twenty-two amino acids used for protein biosynthesis, as well as other amino acids that can be incorporated into proteins during translation. Such amino acids can be a natural amino acid, such as glycine, alanine, valine, leucine, isoleucine, aspartic acid, glutamic acid, serine, threonine, glutamine, asparagine, arginine, lysine, proline, phenylalanine, tyrosine, tryptophan, cysteine, methionine, histidine and beta alanine, or non-natural amino acids and alpha amino acids, beta amino acids, gamma amino acids, and epsilon amino acids (e.g., the amino group is remote relative to the carboxyl group).

The present invention also provides methods for providing, administering, prescribing, or consuming an oxycodone prodrug. The invention also provides pharmaceutical compositions comprising an oxycodone prodrug. The formulation of such a pharmaceutical composition can optionally enhance or achieve the desired release profile.

In a further embodiment of the present invention, non-limiting examples of oxycodone prodrugs of the present invention are shown in Formulae 1-91. It should be noted, in these formulae, that while no salt forms have been depicted, all the formulae compounds can be been prepared as their pharmaceutically acceptable salts, as previously described.

Non-limiting examples of oxycodone prodrugs (Formulae 1-91):

EMBODIMENTS

Various embodiments are listed below. It will be understood that the embodiments listed below may be combined with all aspects and other embodiments in accordance with the scope of the invention.

Embodiment 1

An oxycodone prodrug of the following formula where the prodrug moiety X is attached covalently to the oxycodone molecule via the 6 position ketone enolate oxygen as the enolate ester,

or a pharmaceutically acceptable salt thereof.

Embodiment 2

An oxycodone prodrug of the following formula where the prodrug moiety X is attached covalently to the oxycodone molecule via the 6 position ketone enolate oxygen as the enolate ester, and the prodrug moiety Y is attached covalently to the oxycodone molecule via the 14 position hydroxyl oxygen as the alcohol ester,

or a pharmaceutically acceptable salt thereof.

Embodiment 3

The oxycodone prodrug of embodiment 1 or 2, wherein X and Y are the same or different.

Embodiment 4

The oxycodone prodrug of embodiment 1 or 2, wherein X and Y are prodrug moiety ligands selected from alpha-hydroxy carboxylic acid and derivatives as monomers, alpha-hydroxy carboxylic acid homo-oligomers, alpha-hydroxy carboxylic acid hetero oligomers with another alpha-hydroxy carboxylic acid, alpha-hydroxy carboxylic acid hetero oligomers with amino acids, alpha-hydroxy carboxylic acid hetero oligomers with dicarboxylic acids, alpha-hydroxy carboxylic acid hetero oligomers with fatty acids, fatty acids, and other GRAS-based reagents.

Embodiment 5

The oxycodone prodrug of embodiment 4 wherein homo- and hetero-‘mers’ are both linear and branched ‘mers’. The homo- and hetero-‘mers’ are also cross linked with other GRAS reagents such as alpha-hydroxy carboxylic acid and amino acids.

Embodiment 6

The oxycodone prodrug of embodiment 4 wherein the alpha-hydroxy carboxylic acid is lactic acid, tartaric acid, malic acid, citric acid, mandelic acid, pantoic acid, pantothenic acid and other poly-hydroxy carboxylic acids derived from sugars and carbohydrates. The naturally occurring (L)-isomers, the non-natural (D)-isomers, varying mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, and meso-isomers are all claimed in this invention.

Embodiment 7

The oxycodone prodrug of embodiment 4 wherein the amino acids represented here are both natural (all 22 of the proteinogenic amino acids), and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, varying mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers. The amino acids represented here also include alpha amino acids, beta amino acids, gamma amino acids, and epsilon amino acids (amino group remote relative to the carboxyl group).

Embodiment 8

The oxycodone prodrug of embodiment 4 wherein the fatty acids represented here are long chain carboxylic acids, ranging in lengths between eight carbons (C8) to twenty carbons (C20), and said fatty acids are linear or branched chains, and both saturated and non-non-saturated chains, and in the case of unsaturated fatty acids could be both cis- and trans-isomers (Z and E isomers), wherein examples of such fatty acids include, but are not limited to, sorbic acid, stearic acid, oleic acid, palmitic acid, and linoleic acid.

Embodiment 9

The oxycodone prodrug of embodiment 4 wherein the dicarboxylic acids represented here to make hetero oligomers with alpha-hydroxy carboxylic acid include, but not limited to, fumaric acid, maleic acid, and succinic acid.

Embodiment 10

The oxycodone prodrug of embodiment 1 or 2, wherein X and Y are the same or different and is further represented as X is equal to ligands 1-16 and Y is equal to ligands 1-16 (shown below);

Wherein, in ligands 1-16, CZ=CH2, CHOR1, R1=H, acyl groups from fatty acids, acyl groups from alpha-hydroxy acids, acyl groups from amino acids, and acyl groups from dicarboxylic acids including, but not limited to, fumaric acid, maleic acid and succinic acid, R=Me, Ph, CH2COR2, CHOR1COR2, and COR2 (when n is not zero), R2=OH, or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, and the amino acids represented here depicts both natural and non-non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, or O-alkyl (alkyl esters, where the alkyl group is 1-4 carbon linear and branched, saturated and non-saturated alkyl groups), R3=Me, Ph, CH2COR2, CHOR1COR2, and COR2 (when n is not zero), R4 together with the adjacent nitrogen atom is part of an amino acid and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers (R4 in ligands 10 and 12), R5=H, COR2, CW=(CH2)q, CH═CH (both E and Z isomers), R6=OH or is part of an ester formed by the hydroxyl group of another alpha-hydroxy acid or part of an amide formed by the amine group of an amino acid, or alkyl esters, and the amino acids represented here depicts both natural and non-natural amino acids, the naturally occurring (L)-isomers, the non-natural (D)-isomers, mixtures of (L) and (D) isomers, racemates and mixtures of diastereomers, or R6 is part of an ester with an alkyl group (O-alkyl, alkyl group is 1-4 carbon linear and branched, saturated and non-saturated alkyl groups), and m is an integer selected from 0 to 4, and n is an integer selected from 0 to 2, and q is an integer selected from 2 to 6, and v is an integer selected from 0 to 6.

Embodiment 11

The oxycodone prodrug of embodiment 1 or 2, wherein X and Y are the same or different and is further represented by ligand 17;

Wherein, FA is C8 to C20 saturated fatty acids, C8 to C20 unsaturated fatty acids, including but not limited to, sorbic acid, stearic acid, oleic acid, palmitic acid, linoleic acid. These fatty acids could be both linear and branched chain fatty acids, and in the case of unsaturated fatty acids they could be both cis- and trans-isomers (Z and E isomers).

Embodiment 12

An oxycodone prodrug compound represented by one of formulae 1-91.

Embodiment 13

A composition comprising the compound of any of embodiments 1-11.

Embodiment 14

The composition of embodiment 12, wherein the compound or pharmaceutically acceptable salts thereof maintains a steady-state release curve in blood that provides therapeutically effective oxycodone bioavailability.

Embodiment 15

The composition of embodiment 12, wherein when said composition is administered orally and the bioavailability of oxycodone is maintained.

Embodiment 16

A method of treating pain comprising orally administering the composition of embodiment 12 to a patient.

Embodiment 17

The pharmaceutical composition of embodiment 12, wherein the said composition is a pharmaceutically acceptable salt form.

Embodiment 18

A pharmaceutical composition comprising one or more of the oxycodone prodrugs of embodiment 12 and one or more pharmaceutically acceptable excipients.

EXAMPLES

Processes for Preparing Mono-Substituted Oxycodone Conjugates

Two general procedures have been used for the preparation of various mono-substituted oxycodone prodrug conjugates.

The procedure involves treating oxycodone first with a base followed by reacting the carboxyl-activated prodrug moieties.

General Procedure 1:

Oxycodone coupling with the activated prodrug side chain; (KO^(t)Bu procedure):

To a solution of opioid oxycodone (1.05 g, 3.2 mmol) in THF (10 mL) was added KO^(t)Bu (1M solution in THF, 1.05 eq.) at 0° C., then stirred at ambient temperature for 30 min. The brown solution was cooled down to −78° C. and a solution of Boc-hydroxyl protected Osu-active ester of alpha-hydroxy acid (1.05 g, 3.4 mmol) in THF (20 mL) was added over a period of 5 mins. After stirring the reaction at −78° C. for 30 minutes, it was allowed to warm to RT over a period of 3 hrs. The turbid reaction mixture was poured into saturated (satd) NH₄Cl solution (150 mL), stirred for 5 mins and extracted with EtOAc (250 mL). The organic part was washed with aqueous (aq) NH₄Cl, aq. NaHCO₃, brine, dried over Na₂SO₄ and evaporated to dryness to give the product (1.5 g, purity 96.5%).

In some cases the crude product may require further purification by standard column chromatography.

The product was further characterized by nuclear magnetic resonance (NMR) spectroscopy, mass spectroscopy (MS), and elemental analysis.

General Procedure 2:

Oxycodone coupling with the activated prodrug side chain; (LHMDS [lithium hexamethyl disilaside] procedure):

To a solution of opioid oxycodone (1.05 g, 3.2 mmol) in THF (10 mL) was added LHMDS (LiN(TMS)₂) (1M solution in THF, 1.05 eq.) at 0° C., then stirred at ambient temperature for 30 min. The brown solution was cooled down to −78° C. and a solution of Boc-hydroxyl protected Osu-active ester of alpha-hydroxy acid (1.05 g, 3.4 mmol) in THF (20 mL) was added over a period of 5 mins. After stirring the reaction at −78° C. for 30 minutes, it was allowed to warm to room temperature (RT) over a period of 3 hrs. The turbid reaction mixture was poured into satd NH₄Cl solution (150 mL), stirred for 5 mins and extracted with EtOAc (250 mL). The organic part was washed with aqueous (aq) NH₄Cl, aq. NaHCO₃, brine, dried over Na₂SO₄, and evaporated to dryness to yield the product (1.4 g, purity 95%).

The crude product may contain trace amounts of the bis-series of the prodrug.

In some cases the crude product may require further purification by standard column chromatography.

The product was further characterized by NMR, MS and elemental analysis.

Process for Preparing Di-Substituted Oxycodone Conjugates

A general procedure has been used for the preparation of various di-substituted oxycodone prodrug conjugates (X=Y).

The procedure involved treating oxycodone first with excess base followed by reacting with excess carboxyl-activated prodrug moieties.

General Procedure:

A general procedure has been used for the preparation of various di-substituted oxycodone prodrug conjugates (X=Y).

The procedure involved treating oxycodone first with excess base followed by reacting with excess carboxyl-activated prodrug moieties.

General Procedure:

Oxycodone coupling with the activated prodrug side chain, (LHMDS procedure to prepare the di-substituted oxycodone prodrug conjugates):

To a solution of opioid oxycodone (1.05 g, 3.2 mmol) in THF (15 mL) was added LHMDS (LiN(TMS)₂) (1 M solution in THF, 2.5 eq.) at 0° C., then stirred at ambient temperature for 30 min. The brown solution was cooled to −78° C. and a solution of Boc-hydroxyl protected Osu-active ester of alpha-hydroxy acid (2.2 g, 6.9 mmol) in THF (20 mL) was added over a period of 5 mins. After stirring the reaction at −78° C. for 30 minutes, it was allowed to warm to RT over a period of 3 hrs. The turbid reaction mixture was poured into satd NH₄Cl solution (150 mL), stirred for 5 mins and extracted with EtOAc (250 mL). The organic part was washed with aqueous (aq) NH₄Cl, aq. NaHCO₃, and brine, dried over Na₂SO₄ and evaporated to dryness to give the crude product (2.5 g). The crude product may contain small amounts of the mono-series prodrug, along with bis-series of the prodrug, as the main components. The crude product was further purified and separated the mono- and bis-products by standard column chromatography.

The product was further characterized by NMR, MS and elemental analysis.

Boc Group Deprotection from the Coupled Enol-Ester Prodrug Product:

Boc group protection was used to protect the hydroxyl group(s) of the alpha-hydroxy carboxylic acids. After the oxycodone coupling, the Boc group was removed by the following general procedure. To a solution of the hydroxyl Boc-protected coupled product (1.5 g) in IPAc (15 mL) was added 4N HCl/dioxane (15 mL) and the reaction mixture was stirred at RT for 3 h (white ppt formation takes place after 10-15 mins). The solution was diluted with IPAc 50 mL), stirred for 10 mins. The precipitate was filtered, washed with IPAc and dried to give the deprotected product (quantitative yield). In this case the product is isolated as the HCl salt. HPLC purity ˜95%. The product was further characterized by NMR, MS and elemental analysis.

Boc Group Deprotection from the Coupled Enol-Ester Prodrug Product (Another General Procedure):

A third general procedure was also used to remove the Boc group from the coupled enol-ester prodrug product. To a solution of the above, hydroxyl Boc-protected coupled product (1.5 g) in dichloromethane (15 mL) was added trifluoro acetic acid (15 mL) and the reaction mixture was stirred at RT for 3 hrs. The reaction mixture was concentrated to a dry powder on a rotavap and the residue was further purified by either trituration or chromatography as a TFA salt of the enol ester prodrug product. In this case the product is isolated as the TFA salt. HPLC purity ˜95%. The product was further characterized by NMR, MS and elemental analysis.

Synthesis of the Activated Side Chain —OSu Ester for Oxycodone Coupling

Generally, N-hydroxy succinimide ester activated carboxylic acid of the alpha-hydroxy carboxylic acid was used for oxycodone coupling. To a solution of the hydroxyl Boc-protected alpha-hydroxy carboxylic acid (1 g, 1.1 mmol) and NHS (N-hydroxy succinimide) (1.05 eq) in THF (10 mL) was added a solution of DCC (1.05 eq) in THF (5 mL) at 0° C. The reaction mixture was slowly brought to RT and left overnight at RT. The turbid solution was filtered and the filtrate was used as such for the next step coupling process.

(Depending on specific compound stability, the —OSu ester also can be precipitated and crystallized).

Bioavailability Studies of Oxycodone Prodrug Conjugates

The invention is further demonstrated by pharmacokinetic (PK) studies with oxycodone that has been modified by the covalent attachment of various GRAS-based prodrug moieties at 6 and 14 oxygen positions of oxycodone. Studies include PK evaluations of the various drug conjugates administered by the oral route.

Oral bioavailability studies of oxycodone compared with oxycodone conjugates were conducted in male Sprague-Dawley rats. Doses of oxycodone hydrochloride and oxycodone conjugates containing equivalent amounts of oxycodone were administered in deionized water.

Male Sprague-Dawley rats were provided water ad libitum, fasted overnight and dosed by oral gavage with oxycodone conjugates or oxycodone HCl. All doses contained equivalent amounts of oxycodone base. Plasma oxycodone concentrations were measured by LC/MS.

Rat oral PK profile of oxycodone of these oxycodone prodrug conjugates are shown in FIGS. 1-41. Oxycodone HCl, 5.58 mg/kg (5 mg/kg oxycodone free base) was used as the reference and all the prodrug compounds weights were adjusted to 5 mg/kg oxycodone free base equivalent weight. 

What is claimed:
 1. An oxycodone prodrug of the following formula where the prodrug moiety X is attached covalently to the oxycodone molecule via the 6 position ketone enolate oxygen as the enolate ester,

or a pharmaceutically acceptable salt thereof, wherein X is a) a hetero-oligomer of an alpha-hydroxy carboxylic acid selected from the group consisting of lactic acid, tartaric acid, malic acid, citric acid, mandelic acid, and pantoic acid with a dicarboxylic acid selected from the group consisting of fumaric acid, maleic acid, or succinic acid, or b) a hetero-oligomer of an alpha-hydroxy carboxylic acid selected from the group consisting of lactic acid, tartaric acid, malic acid, citric acid, mandelic acid, and pantoic acid with an amino acid wherein i) a hydroxy group of the alpha-hydroxy carboxylic acid is covalently linked to a carbonyl of the amino acid, and the amino acid of the hetero-oligomer is selected from the group consisting of beta alanine, beta amino acids, gamma amino acids, and epsilon amino acids, or ii) a carboxyl group of the amino acid is covalently linked to the oxycodone and an amino group of the amino acid is covalently linked as an amide to a carboxyl group of the alpha-hydroxy carboxylic acid.
 2. The oxycodone prodrug according to claim 1 wherein the amino acids of compounds (b)(ii) are selected from naturally occurring proteinogenic amino acids, non-natural amino acids, naturally occurring (L)-isomers, non-natural (D)-isomers, mixtures of the (L) and (D) isomers, racemates and mixtures of diastereomers.
 3. The oxycodone prodrug according to claim 2 wherein the amino acids of compounds (b)(ii) are selected from the group consisting of any of the 22 naturally occurring proteinogenic amino acids.
 4. A pharmaceutical composition comprising a compound according to claim 1 and a pharmaceutically acceptable excipient.
 5. The pharmaceutical composition according to claim 4, wherein the compound is a pharmaceutically acceptable salt form.
 6. A method of treating pain comprising administering the pharmaceutical composition according to claim 4 to a patient. 